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eMR Opportunities for the Future
Dr Peter Kennedy,
Clinical Adviser for eHealth NSW
The most mature EMR in the country. Usage growing
From December 2010 -• 111% more users• Daily appointments increased 105%• Daily chart opens were up 122%
across the state• Daily orders were up 102% across
the state
Electronic Medical Record
“Every day, over 32,000 clinicians use the eMR to open 290,000 charts, order 165,000 tests and book 22,000 appointments electronically.”
The most mature EMR in the country. Usage growing
Electronic Medical Record
Concurrent user growth• There has been
significant growth in concurrent users accessing the eMR domains with the roll-out of eMR2, CHOC, eMeds and Rural eHealth Programs.
• Favourable comparisons for Order
Entry and Clinical Documentation
• Cerner and NSW Health have
identified joint initiatives aimed at
taking lead sites in the State,
through and beyond electronic
medications management (eMM)
to HiMSS Stage 6 and ultimately,
Stage 7.
• Sydney Local Health District
(SLHD) and South Western
Sydney Local Health District
(SWSLHD) as well as the Sydney Children’s Hosptial Network
(SCHN) are positioned to be lead
sites for these initiatives.
Maturity, Opportunities
Build Safe systems
People use IT safely
Using IT to improve / monitor safety
Sittig & Singh NEJM Nov 2012
Communication
Leadership Team Work
TeamSTEPPS
Courtesy of the Agency for Healthcare Research and Quality
Situational Awareness
Shared Mental Model
Mutual Support
TeamSTEPPS
Five Dysfunctions
of a Team
1
Absence of trust
2
Fear of conflict
3
Lack of commitment
4
Unwillingness to hold one
another accountable
5
Inattention to results
Patrick Lencioni
Executive Sponsorship
Clinical Leadership
Technical Expertise
Equity
Principles for EMR Rollout
Policy Ministry
Governance
Strategy and Architecture
Local Networks / Bandwidth
Central Infrastructure (Data Centres) and Operations (EMR)
eHealth NSW
Local Project Management, Implementation and Training
Program Management, Procurement
End User Computing (PCs, Mobile Devices, TeleHealth Endpoints, Wireless Networks, Phones)
Ownership
Work Practice Review
Standardisation and Content Knowledge
Education
Clinician Support
Benefits Realisation
ACI / CEC / HETI /NSW Kids and Families
Local Health Districts
Enab
lers
Ch
ange
Man
agem
ent
Risk Category Owner
10
Data Warehouse
Linked data, Trends,
Population Health,
Research
Outcome Measures
Clinical Analytics
eMR, eMeds, Community, ICU
IT Platform
- Standardisation
- Interoperability
- InfrastructureBusiness
Applications
Other Clinical Data
SourcesTechnovigilance
Operational Data
Store
Actionable decision
support,
Patient portal,
Journey board
Provides intelligence
for improvement
Health Research
Public Health
Hospital Management
Clinical dashboards
Decision Support
Patient care
Local care management and planning
Health system management and planning
Health research and development
Daily clinical decisions
Front line clinicians and
individual patients
Policy and Executive
Clinical Directors and Heads of Departments
Researchers
Who would interact with the data
Use their IT system to drive safety, quality, efficiency and effectiveness through:
I. Work practice review
II. Standardisation of care
III. Focusing on the patient
IV. Clinical analytical data that could both drive the change and reflect the change
V. Recognition of high performance
Memorial Hermann HospitalHouston Texas
Complex Adaptive Systems
WORK AS IMAGINED
How managers believe work is being done (rules)
GAP
WORK AS PERFORMEDEvery-day work: How work IS being done
Adapted from: Ivan Pupulidy
Clinical Analytics
Acute Stroke
Acute Stroke Management
Clinical Pathway
• Acute Stroke Management Clinical
Pathway developed with involvement
from
– Agency for Clinical Innovation (ACI)
– Stroke Network Group
– eHealth NSW
Acute Stroke Management
Clinical Pathway
• Multidisciplinary
– Medical
– Nursing
– Allied Health
• Phased Care approach
Acute Stroke Management
Clinical Pathway
• Groupings of orders based on phase of care
including:
– Pathology
– Medical Imaging
– Consults
– Patient Care
– Medical Assessments
– Medications
• Clinical decision support incorporated
• Aligned with best practice guidelines
Quality Informatics
Use Quality Informatics for Stroke related
assessments (FAST, Swallow Screen, Speech
Pathology Assessment, NIHSS)
This screen shows real
time data as of NOW
and allows clinical staff
to act if things aren’t
done.
Assessments /
observations (height,
weight) can be
completed from this
screen
Near real-time insights – summary and patient
level
This screen
shows near-real
time data and
allows clinical
staff to see
variances in
treatment and
outcomes
Users can click
on graphs and
tables to drill
down into the
data